Follow the steps below to register as an out-of-network practitioner with BCBS of North Carolina:


For individuals

  • You will need: 

  • Practitioner License

  • W-9 Form (only for solo practitioners not part of a group)


  1. Navigate to: https://www.bluecrossnc.com/providers/network-participation/individual-practitioner-enrollment-application

  2. Scroll down and select “Non-participating enrollment request status"

  3. Complete the non-participating enrollment form and submit

  4. Email the completed W-9 form to [email protected]




For groups

  1. Navigate to: https://www.bluecrossnc.com/providers/network-participation/provider-group-enrollment-application

  2. Scroll down and select “I want to remain out-of-network"

  3. Complete the non-participating enrollment form and submit.